MRI of a tumour of the right tonsil

Author(s)

Lemort M, Leurquin M

Patient

male, 40 year(s)

Clinical History

Large tumour of the right tonsil extending into the soft
palate and uvula

Imaging Findings

Patient, male 40y old, consults for a pain in the right
tonsilar region. The clinical examination shows a 2 cm
lesion of the right tonsil spreading in the anterior
tonsillar pillar ( palatoglossus muscle). One 2cm ADP is
palpated in the sub-mandibular homolateral aera.
A MRI examination is done using the following sequences :
T1w SE axial pre and post Gd DOTA, T2w FSE coronal. What is
the T stage of this tumour ?

Discussion

It is a T4 tumour because of its extension into the deep
muscles of the tongue.
Staging criteria for primary squamous cell carcinoma of the
oropharynx:
T1: tumour is 2 cm or less in its greatest dimension.
T2: tumour is more than 2 cm but not more than 4 cm in its
greatest dimension.
T3: tumour is more than 4 cm in its greatest dimension.
T4: tumour invades adjacent structures, including bone
(mandible or maxilla), soft tissues of the neck, or deep
(extrinsic) muscles of the tongue.
A biopsy showed a squamous cell carcinoma of the right
tonsil.
The patient was treated by chemo- and radiotherapy and presented with a total remission after one year follow-up.

There is thickening of the uvula, the right lateral and posterior walls of the oropharynx.

Area of Interest:unknown; Imaging Technique:T1W SE axial slices before (1a-1b) and after (1c) contrast enhancement;

There is a massive thickening of the tonsilar area and the right pillars of the soft palate. The tumour shows a homogeneous, intermediate signal.

Area of Interest:unknown; Imaging Technique:T1W SE axial slices before (1a-1b) and after (1c) contrast enhancement;

There is a strong, homogeneous enhancement after Gd injection. The limits of the lesion in the pharyngeal wall are more clearly shown. Note the crossing of the midline as the invasion of the anterior part of the...

Area of Interest:unknown; Imaging Technique:T1W SE axial slices before (1a-1b) and after (1c) contrast enhancement;

Note the well depicted invasion of the soft palate and uvula. However, oedema may contribute to the thickening and high signal in the tumour area. So the extent has to be compared with the T1W post contrast scans.

Area of Interest:unknown; Imaging Technique:T2W FSE coronal images;

This more anteriorly situated slice shows the invasion of the tongue muscles, the tumour crossing the amygdalo-glossus groove.

There is thickening of the uvula, the right lateral and posterior walls of the oropharynx.

Figure 1b

There is a massive thickening of the tonsilar area and the right pillars of the soft palate. The tumour shows a homogeneous, intermediate signal.

Figure 1c

There is a strong, homogeneous enhancement after Gd injection. The limits of the lesion in the pharyngeal wall are more clearly shown. Note the crossing of the midline as the invasion of the anterior part of the paratonsilar space.

Figure 2

T2W FSE coronal images

Figure 2a

Note the well depicted invasion of the soft palate and uvula. However, oedema may contribute to the thickening and high signal in the tumour area. So the extent has to be compared with the T1W post contrast scans.

Figure 2b

This more anteriorly situated slice shows the invasion of the tongue muscles, the tumour crossing the amygdalo-glossus groove.